CHS 446 Communication Skills for the Healthcare Professional

Communication Skills

CHS 446

Communication Skills for the

Healthcare Professional

Mohammed S. Alnaif, Ph.D.

[email protected]

07/02/1437 1 Mohammed Alnaif Ph,D

mailto:[email protected]

Interviewing Techniques


An important and fundamental step in providing medical care is the patient interview. To properly diagnose the patient’s conditions and to develop the appropriate treatment plan, the healthcare professional, needs to obtain thorough and accurate medical history from the patient.




There are three primary functions of the medical interview:

Information gathering

Relationship building

Patient education



Patient Interview

There are two common approaches to the patient interview:

The primary care provider only approach, primary care providers interview the patient themselves. In this way the patient is required to relate their medical history only once.

The team approach, the patient is interviewed more than once. The first interview is conducted by a member of the healthcare team, such as a nurse or a medical assistant. This is followed by a subsequence interview conducted by the primary provider, such as a physician, physician assistant, or nurse practitioner.



Patient Interview

The practitioner patient relationship is often an

unequal one.

Healthcare Professionals are knowledgeable

about their area of practice and the patient is

dependent upon this expertise

HCP should display an attitude of competence

and professionalism and also communicate a

sense of trust and confidentiality.



The Interviewee

The patient is typically the primary source

of medical information for this reason; the

HCP will interview the patient directly.

There are also instances in which the

patient may be unable to provide their

medical history directly to the practitioner.



The Interviewee

Patients who are critically ill, or even unconscious, mentally impaired, or very young cannot effectively communicate with their caregivers.

In these cases, other sources are necessary to provide the required medical information.

Family Members

Other healthcare team members

Medical records



The Interviewee The presence of family members during the visit may offer many significant benefits during the medical interview.

Family members may help communicate the patient’s concerns to the HCP

Improve the HCPs understanding of the patient’s problem

Improve the patient’s understanding of the diagnosis and treatment

Help the patient to remember clinical information and recommendation

Express concerns regarding the patient

Assist the patient in making decisions



The Setting

The interview between the HCP and the patient may take place

face-to-face in the doctor’s office or in a hospital or a clinic.

Patients should be escorted to an area that is both private and

comfortable, usually the examination room.

This way patient confidentiality is maintained

The HCP provider is able to observed any nonverbal behaviors

exhibited by the patient

These observations which may be helpful in diagnosing the

patient or in developing the treatment plan should be noted on

the medical history form.



The Setting

The patient interview may also take place on the telephone.

In this case, the HCP is unable to observe the patient’s

facial expressions, cannot make eye contact with the

patient, and is unable to receive any visual feedback, such

as body language.

Instead the practitioner conducting the interview relies on

the patient’s tone, pacing of speech, and word selection to

interpret their condition and attitude.



Type of Questions

There are two types of questions that the HCP will ask the patient

during the interview:

Closed direct questions and open-ended questions.

Closed questions are designed to elicit short, focused responses

such as simple yes and no.

Have you ever had rheumatic fever?

Have you ever had jaundice or hepatitis?

Do you use tobacco?



Type of Questions

Other examples of closed questions

Where does it hurt?

Did you have a fever this morning?

Closed questions quickly provide a great deal of objective

information about the patient.

The HCP will only have 15 minutes with the patient, and

these questions will allow for the most efficient

communication.



Type of Questions

Open-ended questions

Conversely much important information, both objective

and subjective, regarding the current physical and

emotional conditions of the patient can be obtained only by

way of open-ended questions.

These questions often begin with who, what, where, when,

how, and why.

Open-ended questions cannot be answered simply and

require more discussion regarding a given health issue.



Type of Questions


These are the questions that help to establish therapeutic

communication and relationship between the patient and

the HCP

The patient is required to provide more explanation when

responding to these questions.

Open-ended questions often begin with how or what.

Examples of these questions include the following:

How are your stress levels at work?

How does this pain feel like?



Type of Questions


Open-ended statements may also be useful

Describe when this occurs

Give me an example

Why don’t you take your medication?

Why did you do that?

There may be no one true answer to the why question, as a

patient’s motivation is often complex.



Type of Questions


In addition, these questions may be perceived as

confrontational.

The patient may feel as though they have to defend

themselves, this likely to inhibit further communication and

damage the therapeutic relationship between the

practitioner and the patient.

On the other hand, there are times when “WHY” questions

are useful.



Type of Questions


For example, to engage in true collaborative decision

making it is necessary for the HCP to know what motivates

the patient.

The HCP will often need to ask the patient about the

factors that might influence their ability to follow a certain

treatment regimen.

Why are concerned about taking this medication?

Why are you worried about starting this diet?



Type of Questions


These questions are meant to improve the HCP’s

understanding of how the patient feels about a given issue.

The use of leading questions and statements should be

avoided

“I assume you have shortness of breath.”

These types of questions or statements are likely to prompt

or encourage the patient to provide what they perceive is

the desired answer.



Type of Questions


If the patient does not fully understand the content of the

question, they may compelled to simply go along with the

HCP to avoid appearing disagreeable.

These responses may in fact, be inaccurate and have a

negative impact on the medical interview.

Indirect statements are used to establish therapeutic

communication and relationship between the practitioner

and the patient.

“till me about the diet you are on”



The HCP-centered Interview versus the Patient-centered

Interview

Consider the following interview between a healthcare

professional and their patient:

HCP: “What brings you hear today?”

Patient: “I have chest pain.”

HCP: “How severe is it?” “When does it occur?” “What do

you do to relieve it?”

This is an example of a healthcare centered interview where

the healthcare provider controls the dialog.



The HCP-centered Interview versus the

Patient-centered Interview

The stream of questions in response to the

patient’s first compliant may, in fact,

interrupts the patient, and may prevent the

patient from continuing to express all of

their concerns.




Interview

Contrast the previous interview with the following

interview:

HCP: “What brings you hear today?”

Patient: “I have chest pain.”

HCP: “What else?”

Patient: “I have been having a lot of trouble sleeping.”

HCP: “Anything else?”

Patient: “Well I have been very worried about my job . I

am afraid that I may be laid off.”




Interview

This is an example of a patient-centered interview where

the HCP uses “continuers” expressions that encourage the

patient to reveal all of their concerns at the beginning of the

interview.

The HCP allows the patient to tell their story and guides the

patient to provide the important details by using both open-

ended questions and indirect statements as well as specific

closed questions. This approach provides the best

information




Interview

This approach provides the best information.

The use of continuers also contributes to the development of

relationship between the HCP and their patient at the outset

of their interaction.

Finally the patient-centered approach allows the HCP to be

more attentive to the nonverbal messages expressed by the

patient.


CHS 446 Communication Skills for the Healthcare Professional

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